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Volume 1, Number 1, 1996

Stereotactic radiosurgery and radiotherapy. Radiobiology and treatment planning

J. Novotny, V. Vladyka, R. Liscak, D. Urgosik, G. Simonova, J. Novotny Jr


Stereotactic radiosurgery (SR) is the treatment of small lesions in the brain using external beams of radiation. The treatment is performed in one single fraction with the use of high dose. The beams are guided to the desired point within the brain using very accurate, 3-dimensional imaging procedures (Leksell, 1951).
Stereotactic radiotherapy (SRT) is the treatment of small or medium lesions in the brain with fractionated regimes employing stereotactic method. This procedure differs from conventional radiotherapy in that the volume of tissue is usually smaller, the number of fractions delivered is much smaller, and the dose per fraction is much larger. The strategy of radiosurgery or stereotactic radiotherapy is to use the localisation of a high radiation dose to the volume of the target lesion to effect the desired biological sequalae, while sparing adjacent normal tissues.
Although stereotactic radiosurgery has traditionally been kept distinct from radiotherapy, the two fields are rapidly converging. In SR and SRT, improved dose localisation is achieved by using Stereotactic apparatus to pinpoint the target volume, and by using special irradiation schemes and technology to deliver it precisely. Dose distributions with steep fall-off have been achieved primarily by a large number of ports or arcs (photon SR or SRT) or by improved depth dose characteristics (charged particle SR and SRT). Radiotherapy, too, is riding a wave of technological achievements that is carrying it to ever better dose distributions. Multileaf collimators, sophisticated 3-dimensional treatment planning programs for conformal therapy, computerised delivery systems, on-line portal imaging systems and megavoltage X-rays areall components of this effort. Improved diagnosis and better target localisation with CT and MRI are helping to heighten confidence in the volume needed to be treated. In the future, then advantages and techniques of radiosurgery and stereotactic radiotherapy; become of more interest and use to the radiotherapist, and they will take their pace alongside the other, more established, methods.

Signature: Rep Pract Oncol Radiother, 1996; 1(1) : 39-44

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